Sir.—I found the recent report by Preis1 on the use of a fiberoptic guide for endotracheal intubation to be interesting but probably of limited usefulness in the neonatal intensive care unit. Since many endotracheal tubes are placed or changed because of deterioration in pulmonary function, the fiberoptic guide may aid in initial tube placement and localization, but it will not obviate the need for roentgenographic studies required to rule out any underlying lung pathology. Practically speaking, are the radiation risks to patients actually being reduced in the author's neonatal intensive care unit now because roentgenographic confirmation is no longer utilized following every intubation?
Another suggested application exists when clinical suspicion of tube dislodgement or, I would presume, erroneous esophageal intubation occurs. Since the esophagus is in close proximity to the trachea between C2-4 and T3-4, I would expect the relationship of the transilluminated image to skeletal landmarks to
MILSTEIN JM. Fiberoptic Guide for Endotracheal Intubation. Am J Dis Child. 1985;139(5):442. doi:10.1001/archpedi.1985.02140070016012